Covid-19 pandemic has had drastic effects on radiology practice across the globe, not only in terms of case volume but also in the offsite flow of work and modifications in the interventional processes. Researches and surveys conducted in different departments have shown the impact of the pandemic. Covid-19 pandemic has upturned the medical practices owning to daily changing government policies and patient needs.

During the peak of the crisis situation, radiology departments across the globe witnessed a massive decline in the volume of imaging procedures pouring in. The financial crisis, public policies, and fearful patients can be some of the factors attributed to such a decline. As compared to 2019, the total imaging demands have declined drastically in almost all fields.

According to investigators, a similar decline in radiology practices can be expected over the coming months as well, for at least 3-4 months. However, that may differ as per the severity of the virus in a particular location.

Interventional Modifications 

Starting in March 2020, hospitals and healthcare units started postponing elective medical procedures and surgeries, so that staff members from the ICUs and operating rooms could be made available for Covid-19 patients. They assigned interventional radiologists to intensive care units, where they were expected to give bedside venous options to the patients in need. They also created special ambulance teams to conduct bedside processes like drainages, paracentesis and thoracentesis under ultrasound-guidance.

When compared to the volume of interventional procedures of 2019 and 2020 in the months of March and April, a significant reduction of around 46% was noticed. A similar decline was also noted in fluoroscopy and CT guided procedures. All these observations indicate significant modifications in the caseloads and work patterns across varied specialties in the industry. Since Covid-19 is not going to subside any time soon, it is important to take these signals as warnings and reallocate resources to departments where they are needed the most.

Shifts in Offsite Flow of Work

The offsite work of radiologists has also been severely affected due to the Covid-19 crisis, and such a situation is expected to continue even after the situation gets under control. A large number of radiology departments are integrating teleradiology practices to handle their workflow during normal work shifts. With sufficient benefit, many radiologists are making up their minds to follow similar practices after the COVID situation too.

According to a survey, teleradiology was used overnight and call shifts only, but the pandemic situation has changed this mindset and staff members are being provided with home workstations to carry out their practices. With this technology, radiologists can now offer remote reading services. Most of the respondents reported fewer interruptions, improved turnaround time for the reports, reduced stress levels, and unchanged rapport with their peers.

More than 50% of the members reported sufficient benefit from internal teleradiology and they have plans to continue a similar flow of work even after the industry comes back to normal.

Rescheduling of Elective imaging Procedures

A team from the University of Cincinnati Medical Center, Ohio, reported that they started rescheduling their non-urgent imaging procedures and divided them into three tiers of prioritization. These included:

• Tier 1: These included imaging studies that could be done without a radiologist’s approval, like changes in the mental state, newly developed deficit in the focal neurological system, or computed tomography pulmonary angiography. Tests coming under this category continued.
• Tier 2: Neoplasm imaging processes for active diseases that required progressive findings were also continued. These include recent imaging and surgical procedures with symptoms of recurrence or complication.
• Tier 3: Imaging and screening procedures for chronic pain, malignancy, lung cancer, breast cancer and those with abrupt indications were postponed and rescheduled.

In total, around 30,000 imaging studies were suspended during this period. The overall volume of imaging procedures declined by more than 50% as compared to the same months in 2019. A similar decline was also noticed in inpatient volumes, outpatient volumes, and emergency procedures.

As the Covid-19 cases start plateauing across the globe, an active recovery plan also needs to be made by experts. The major part would be to make a re-entry in a phased way while ensuring sanitization and social distancing rules. As the industry bounces back, it is important to ensure the hospital as well as patient safety in the imaging facilities.

According to experts, a proper strategy needs to be made, so that issues can be tracked and issues can be resolved in a systematic way. Apart from reducing the number of imaging facilities and technologists on the sites, shifts may also be staggered to minimize exposure.

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